Althea Johnson
Lauderdale Lakes
Summary
Experienced Registered Nurse Case Manager with 20 years in integrated care management, patient assessment, and discharge planning. Known for coordinating complex medical and behavioral health needs, improving continuity of care, and reducing readmissions.
Overview
1
1
Certification
21
21
years of professional experience
Work History
Registered Nurse Case Manager
Centene
01.2016 - Current
- Assessed member conditions, identified care gaps, and prioritized appropriate interventions.
- Collaborated with physicians, providers, and community resources to support continuity of care.
- Managed care coordination plans for members with complex medical and behavioral health needs.
- Reviewed clinical documentation to determine service necessity and appropriate level of care.
- Educated members on treatment plans, self-management, and available benefits.
- Documented case management activities accurately in care management systems and medical records.
- Evaluated patient progress and adjusted care plans accordingly, ensuring continuity of care across all healthcare settings.
- Provided education and support to patients and families, empowering them to make informed decisions regarding their healthcare needs.
- Applied utilization management guidelines to support timely, evidence-based care decisions.
- Monitored discharge planning and arranged follow-up services to reduce care disruptions.
- Improved patient outcomes by consistently providing comprehensive assessments and developing tailored care plans.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Streamlined care coordination processes to reduce hospital readmissions and emergency department visits.
- Conducted comprehensive assessments of patients'' physical, emotional, and social needs in order to develop individualized care plans that facilitated optimal health outcomes.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Developed care plans based on nursing diagnosis and incorporated therapeutic, preventive and rehabilitative nursing methods.
- Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
- Mentored new nursing professionals during orientation periods, fostering a collaborative team dynamic that supported the delivery of high-quality care.
- Liaised with physicians regarding patient needs, performance and changes.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Disease Management Nurse
Optum Health Care
05.2006 - 01.2016
- Developed individualized care plans supporting medication adherence, symptom monitoring, and self-management goals.
- Coordinated with physicians, pharmacists, and care teams to close gaps in treatment and follow-up.
- Educated members on condition-specific protocols, lifestyle changes, and preventive care resources.
- Conducted telephonic assessments to identify chronic condition risks and appropriate disease management interventions.
- Documented clinical findings, care recommendations, and outreach outcomes accurately in care management systems.
- Reviewed utilization patterns and prior authorizations to support timely, appropriate care transitions.
- Ensured continuity of care by communicating regularly with primary care providers and specialists regarding patient progress.
- Developed targeted nursing interventions based on analysis of data from electronic health records, leading to improved patient outcomes.
- Reduced hospital readmissions through proactive monitoring of patients with chronic conditions and timely interventions.
- Collaborated with case managers to optimize care coordination efforts for patients transitioning from hospital to home or other care settings.
- Promoted patient self-management by providing education on medications, nutrition, exercise, and lifestyle modifications.
Education
Bachelor of Science - Nursing
University of Phoenix
Tempe, AZ06-2012
Skills
- Integrated care management
- Care coordination
Care coordination optimization
- Discharge planning
- Patient assessments
- Medical evaluation
- Referral coordination
- Medical records management
- Staff management
- Goal setting
- Behavioral health integration
- Teamwork and collaboration
Certification
- Certified Case Manager
Timeline
Registered Nurse Case Manager
Centene
01.2016 - Current
Disease Management Nurse
Optum Health Care
05.2006 - 01.2016
Bachelor of Science - Nursing
University of Phoenix